ED Simulator Based Training – Scenario Guide Set Scenario (Start) Scenario (Progression) Equipment Adult 75 yr old male is brought to Resus by paramedics with the history of cough and DIB for 2 days. He is k/c of COPD and has worsening of cough for last 1 day. His wife reports fever upto 38.8 C.He has been more confused since morning. PMH COPD,HTN DHx Lisinopril, Salbutamol , Beclometasone SHx Drinks alcohol on weekends, ex-smoker ET 15 yards.Uses mobility scooter to go outside. Blood gas shows Type 2 respiratory failure.COPD initial care bundle is carried. After nebs,pt becomes more drowsy and GCS drops to 11-13. Repeat ABG shows worsening of acidosis and increase in CO2. Initiate NIV.Appropriate decides excalation of care. Sim-Man (complete kit) Lifepak defib with training leads NIV Training ‘resus’ equipment trolley ED Resus Room Time: (45 mins) Simulation: 30 Debrief: 10 Recover: 5 Required documents ED and nursing sheets Resp failure performa Main objectives (Clinical and Educational Context): To demonstrate effective, structured A-E primary assessment and to make a clinical diagnosis of Hypercapnic Respiratory failure(type II) Effective and appropriate clinical management using Acute Hypercapnic Respiratory failure pathway Deals with escalation of care appropriately Consultation with Resp Reg for admission to CDU Simulator start state Position Semi-recumbent on ED trolley in resus bay Physiology A – Clear & self maintaining. B - Rate 29, SpO2 98% 15L NRB. C - Pulse 130, BP 90/95. D – E4 V5 M6 pupils equal E – Tpr 38.1 Clinical Findings B/L wheezes tachypnea Expected course: Primary survey identification of Type II Resp failure Initiation of COPD bundle(Hypercapneac failure Performa) recognition of worsening Initiation of NIV Discusses with wife about ceiling of care

ED Simulator Based Training – Scenario Guide